​The addition of Metronidazole to an antibiotic regimen is something generally done without much concern. We ‘trust’ Metronidazole to not cause resistance, and to do the job we ask of it. Why is that? I honestly can’t remember ever looking after a patient with an anaerobic infection resistant to Metronidazole.

When a doctor diagnoses atrial fibrillation, 'the guideline' says that a CHA2DS2VASc and HAS-BLED score should be calculated, and depending on the outcome an anticoagulant given. We see a lot of AF in the critical care (not as much as in CICU but that’s a different game), but we don’t follow the guidance. Or at least I don’t, but why?

Whether all critically ill patients need the routine administration of stress ulcer prophylaxis (SUP) has been controversial for over 20 years.Much of the evidence both for and against is of poor quality, and is pretty old.

Do beta blockers help the body survive the stress response? It's fairly well accepted that chronic beta blockade should not be withheld at times of stress. The POISE trial considered whether starting beta blockers before major non cardiac surgery improved outcome (it didn't - the results showed less MI but more CVAs and increased mortality). This paper goes towards considering the same for sepsis.